Provider Demographics
NPI:1992874325
Name:SELECT CARE AGENCY, INC.
Entity type:Organization
Organization Name:SELECT CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LIDIA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-279-9024
Mailing Address - Street 1:10240 SW 56TH ST
Mailing Address - Street 2:SUITE 113-C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7071
Mailing Address - Country:US
Mailing Address - Phone:305-279-9024
Mailing Address - Fax:305-279-9171
Practice Address - Street 1:10240 SW 56TH ST
Practice Address - Street 2:SUITE 113-C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7071
Practice Address - Country:US
Practice Address - Phone:305-279-9024
Practice Address - Fax:305-279-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health